1. PRESENTED BY: SUPARNA DEY CHOUDHURY BPT 3 rd Year Regional college of paramedical health science

2. TOPICS:- INTRODUCTION OF ARTHROPLASTY. ARTHROPLASTY OF HIP JOINT.  Types of arthroplasty of hip joint.  Replacement Arthroplasty and its types.  Hemi replacement Arthroplasty.  Total Hip Replacement and its Types.  Excisional arthroplasty PHYSIOTHERAPEUTIC MANAGEMENT OF HIP JOINT ARTHROPLASTY.  PRE OPERATIVE REGIME  POST OPERATIVE REGIME ARTHROPLASTY OF KNEE JOINT INDICATIONS CLASSIFICATION PHYSIOTHERAPEUTIC MANAGEMENT OF KNEE JOINT ARTHROPLASTY

3. Arthroplasty is an orthopaedic surgical procedure where the articular surface of a musculoskeletal joint is replaced, remodelled, or realigned by osteotomy or some other procedure.orthopaedic surgical procedure Indication: done to relieve pain and restore function to the joint after damage by arthritis or some other type of trauma.

4. ARTHROPLASTY OF HIP JOINT This may be of two types:- 1. REPLACEMENT ARTHROPLASTY 2. EXCISIONAL ARTHROPLASTY

5. REPLACEMENT ARTHROPLASTY Replacement arthroplasty is reconstruction of the joint by replacing the joint partially or totally HEMIREPLACEMENT ARTHROPLASTY TOTAL HIP REPLACEMENT ARTHROPLASTY

6. This is indicated in fracture of the femoral neck in elderly patients. In this operation,the femoral components of the head and the neck are replaced with a metal prothesis. The two prosthesis:- Austin Moore Thompson HEMIREPLACEMENT ARTHROPLASTY

7.  Now-a-days,a bipolar prosthesis is more common. PROCEDURE:- The stem of the prosthesis is implanted into the upper shaft of the femur with help of bone cement while the head of the prosthesis is put in the acetabulum inside acup which moves freely into the acetabulum. ADVANTAGE :- The wear of the acetabulum is relatively less.

8. TOTAL HIP REPLACEMENT Surgery in which the ball and socket of the hip joint are completely removed and replaced with artificial materials. A metal ball with a stem is inserted into the femur and an artificial plastic cup socket is placed in the acetabulum.plastic

9. NONCEMENTED IMPLANT CEMENTED IMPLANT TOTAL HIP REPLACEMENT

12. EXCISIONAL ARTHROPLASTY  INDICATIONS:- 1. An advanced case of tuberculosis of hip. 2. Severe osteoarthritis. 3. Painful ankylosis. 4. Septic arthritis of hip. 5. Pyogenic infection of hip 6. Unsuccessful case of THR or failed open reduction. DEFINATION:- In this procedure, the femoral head and neck are resected down to the base of the trochanter ; the superior margin of the acetabulum is also resected to curette out the diseased portion. A gap is thus created between the acetabulum and the trochanter.

13. PHYSIOTHERAPY MANAGEMENT PRE-OPERATIVE REGIME:- 1.EVALUTION: The following parameters are evaluated: 1. Pain 2. Deformity 3. Range of motion at hip and related joints 4. Muscle power and muscle atrophy 5. Ambulation and gait 2.EDUCATION OF THE PATIENT: It is important to educate the patient on the exact regime of physiotherapy be followed in the early postoperative period.

14. PRE-OPERATIVE REGIME  DEEP BREATHING AND COUGHING- to improve vital capacity of lung ;get rid of postanaesthetic secretions.  STRONG AND SUSTAINED ISOMETRIC CONTRACTION OF GLUTEI,QUADRICEPAND HAMSTING- to improve strength and endurance of both the limbs.  GUIDANCE ON RANGE OF MOTION AND STRENTHENING EXERCISES- to avoid stiffness and incordination  RESISTIVE EXERCISES FOR ANKLE AND FOOT ON THE AFFECTED SIDE-for weight bearing muscle groups of both the arms and to facilitate early ambulation with the walking aids.  PROPER LIMB POSITIONING IS TAUGHT-to avoid hip dislocation in post operative period.  TECHNIQUES OF TRANSFER IS TAUGHT  MENTALLY PREPARING THE PATIENT FOR PAINFUL ACTIVE STAGE AHEAD.

15. POST OPERATIVE REGIME DAYSPHYSIOTHERAPY TREATMENT DAY - 1 1.CHEST PT 2.VIGOROUS ANKLE AND TOE MOVEMENTS 3.ISOMETRICS OF QUADRICEPS DAY - 2 1. SITTING UP BY GRADUALLY RAISING THE BACK REST 2.BED TRANSFER 3.STANDING, WALKING WITH PARTIAL WEIGHT BEARING OR TOE DOWN WEIGHT BEARING WITH A WALKER DAY - 3 1.ISOMETRICES TO GLUTEUS MAXIMUS,MINIMUS,MEDIUS 2.ASSISTED HIP FLEXION (HEEL DRAG) AND HIP ABDUCTION 3.INITIATE PRONE LYING 4.THOMAS STRETCH 5.RELAXED PASSIVE HIP MOVEMENTS

16. POST OPERATIVE REGIME WEEKSPHYSIOTHERAPY TREATMENT WEEK 2: ACTIVE HIP FLEXION, KNEE EXTENSION WEEK 3: PWB WALKING ON CRUTCHES WITH FREE SWINGING OF THE OPERATED LEG WEEK 4: 1.PEDO CYCLING OR STATIC BICYCLING 2.STAIR CLIMBING GOING UP WITH THE GOOD LEG FIRST.COMING DOWN WITH THE OPERATED LEG FIRST. 3.INITIATE LEG ROTATION IN SUPINE AND PROGRESS AGAINST GRAVITY AND AGAINST RESISTANCE. WEEK 5-6 1.GRADUALLY INCREASING HIP ABDUCTION AND ROTATION IN SUPINE AND BED SIDE SITTING WEEK 6-7 1.ACHIEVING NEAR NORMAL STRENGTH, ROM BALANCE STANDING ON THE OPERATED LEG ALONE

17. POST OPERATIVE REGIME AMBULATION AND WEIGHT BEARING SCHEDULE  CEMENTED PROSTHESIS: As the stability of the prosthesis is achieved within 15 mins of surgery, weight bearing to tolerate can be started on a walker immediately or on the second day. 1. Progress to crutch walking and continue crutch walking up to 6 weeks. 2. Use a cane for 4-6 months  NON CEMENTED PROSTHESIS: 1. PWD OR TDWB ON WALKER FOR 6 weeks 2. Progress to crutch walking and continue up to 18 weeks 3. Use cane for 4 -6 months

18. KNEE ARTHROPLASTY

19. TOTAL KNEE RELACEMENT ARTHROPLASTY INDICATIONS: 1. UNREMITTED SEVERE PAIN IN THE KNEE 2. DEFORMITY 3. OSTEOARTHRITIS 4. RHEUMATOID ARTHRITIS

20. TOTAL KNEE RELACEMENT ARTHROPLASTY CLASSIFICATION OF TKR: 1.UNICOMPARTMENTAL(UNICONDYLAR)

21. TOTAL KNEE RELACEMENT ARTHROPLASTY 2. BI COMPARTMENTAL

22. TOTAL KNEE RELACEMENT ARTHROPLASTY 3.TRI COMPARTMENTAL

23. DAYS PHYSIOTHERAPY TREATMENT DAY -11.CHEST PT 2.VIGOROUS TOE AND ANKLE MOVEMENT 3.MAINTAIN THE LIMB IN EXTENSION(with heel or lower leg resting on pillow) 4.STATIC GLUTEI BY PRESSING TH EPILLOW BELOW THE HEEL 5.GENTLE ISOMETRICS TO QUADRICEPS DAY – 2 - 31.TRANSFER IN BED 2.GENTLE PATELLAR MOBILIZATION 3.RAPID ISOMETRICS TO QUADRICEPS(SPEDY WITH 10s HOLD) 4.HEEL ASSISTED SLR 5.STAND AND AMBULATE WITH A WALAKER 6.NONTOUCH SLR DAY – 4 - 61.TRANSFER IN CHAIR 2.SELF ASSISTED PASIVE KNEE FLEXION Heel drag in supine Bedside sitting,relaxed knee movements Sitting with the feet planted on the ground 3. CPM 5 – 10 DEGREE DAILY 1 CYCLE PER MIN 4. ACTIVE AND ACTIVE ASSISTE D EXER CISE POST OPERATIVE REGIME

24. DAYSPHYSIOTHERAPY TREATMENT DAY- 7-10 1.WORK UP TOWARDS 90 DEGREE KNEE FLEXIONBY 10 – 14 DAYS 2.HAMSTINGS STRENGTHENING 3.ASSISTED STEP AND STAIRS DAY 11 – WEEK3PROGRESS ALL EXER CISE WEEK- 4-61.WORK UP TOWARDS KNEE FLEXION- 110 TO 150 DEGREE 2.QUADRICEPS DIPS AND STEP UP 3.STATIONARY BICYCLE 4.TWB WITH CANE WEEK 6-11PROGRESSIVE WEIGHT BEARING WALKING WITH CANE.FWB BY 12 WEEKS

25. REFERENCE 1. ESSENTIALS OF ORTHOPEDICS AND APPLIED PHYSIOTHERAPY